Publications by authors named "Kevin Callison"

10 Publications

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Smoking cessation and weight gain: Evidence from China.

Econ Hum Biol 2021 Jul 16;43:101045. Epub 2021 Jul 16.

Department of Economics, Georgia Southern University, United States. Electronic address:

Cigarette smoking has long been viewed as a means to control body weight. However, studies on the association between smoking cessation and weight gain have reported mixed findings and, notably, there is limited evidence among the Chinese population - the world's largest smoker population. The extent to which smoking cessation is positively associated with body weight is of interest as excessive weight gain contributes to heart disease, diabetes, hypertension, musculoskeletal disorders, and some cancers. Additionally, concerns over weight gain may dissuade current smokers from quitting. Using data from the China Health and Nutrition Survey (CHNS), we examine the association between smoking cessation and body weight in China. To account for the nonrandom nature of smoking cessation, our research design relies on within-individual variation in smoking status to remove the influence of time-invariant unobserved differences across individuals that are correlated with both cessation and body weight. We find that smoking cessation is associated with a modest increase in weight (0.329 kg, 0.51 % off the mean) and no significant changes in the prevalence of overweight or obesity.
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http://dx.doi.org/10.1016/j.ehb.2021.101045DOI Listing
July 2021

Medicaid Expansion and Medical Debt: Evidence From Louisiana, 2014-2019.

Am J Public Health 2021 08 2;111(8):1523-1529. Epub 2021 Jul 2.

Kevin Callison and Brigham Walker are with the Department of Health Policy and Management, Tulane School of Public Health and Tropical Medicine, New Orleans, LA. Brigham Walker is also with ConcertAI, Boston, MA.

To identify the association between Medicaid eligibility expansion and medical debt. We used difference-in-differences design to compare changes in medical debt for those gaining coverage through Louisiana's Medicaid expansion with those in nonexpansion states. We matched individuals gaining Medicaid coverage because of Louisiana's Medicaid expansion (n = 196 556) to credit report data on medical debt and compared them with randomly selected credit reports of those living in Southern nonexpansion state zip codes with high rates of uninsurance (n = 973 674). The study spanned July 2014 through July 2019. One year after Louisiana Medicaid expansion, medical collections briefly rose before declining by 8.1 percentage points (95% confidence interval [CI] = -0.107, -0.055;  ≤ .001), or 13.5%, by the third postexpansion year. Balances also briefly rose before falling by 0.621 log points (95% CI = -0.817, -0.426;  ≤ .001), or 46.3%. Louisiana's Medicaid expansion was associated with a reduction in the medical debt load for those gaining coverage. These results suggest that future Medicaid eligibility expansions may be associated with similar improvements in the financial well-being of enrollees.
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http://dx.doi.org/10.2105/AJPH.2021.306316DOI Listing
August 2021

Associations Between Individual Demographic Characteristics And Involuntary Health Care Delays As A Result Of COVID-19.

Health Aff (Millwood) 2021 05 21;40(5):837-843. Epub 2021 Apr 21.

Jason Ward is an associate economist at the RAND Corporation in Santa Monica, California.

The COVID-19 pandemic has disrupted access to medical care for millions of Americans, yet information on the individual characteristics associated with these disruptions is lacking. We used recently released data from the Current Population Survey's supplemental COVID-19 questions to provide the first evidence on associations between individual characteristics, including age, sex, race/ethnicity, education, health status, work-limiting disabilities, health insurance coverage, and employment, and the propensity to experience an involuntary care disruption resulting from the COVID-19 pandemic. is defined as delayed or cancelled care that was not initiated by the patient. Results indicate that older age, being in fair or poor health, greater education, and having health insurance coverage were associated with greater likelihood of experiencing an involuntary delay in accessing medical care. In addition, White, non-Hispanic respondents had higher rates of involuntary care delays than respondents of other races/ethnicities. Our findings provide useful guidance for researchers examining the health consequences of COVID-19-related care disruptions and for policy makers developing tools to offset the potential harms of such disruptions.
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http://dx.doi.org/10.1377/hlthaff.2021.00101DOI Listing
May 2021

Medicaid Expansion Reduced Uncompensated Care Costs At Louisiana Hospitals; May Be A Model For Other States.

Health Aff (Millwood) 2021 03;40(3):529-535

Mark L. Diana is a professor in the Department of Health Policy and Management, Tulane School of Public Health and Tropical Medicine.

We examined changes in hospital uncompensated care costs in the context of Louisiana's Medicaid expansion. Louisiana remains the only state in the Deep South to have expanded Medicaid under the Affordable Care Act and can serve as a model for states that have not adopted expansion, many of which are located in the South census region. We found that Medicaid expansion was associated with a 33 percent reduction in the share of total operating expenses attributable to uncompensated care costs for general medical and surgical hospitals in Louisiana in the first three years after expansion. Reductions varied by hospital type, with larger effects found for rural and public hospitals versus urban and for-profit or private nonprofit hospitals. As hospital operating expenses consistently increased during the sample period, our results imply that hospitals in Louisiana are treating fewer patients for whom no reimbursement was provided since the state expanded Medicaid.
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http://dx.doi.org/10.1377/hlthaff.2020.01677DOI Listing
March 2021

Medicaid Expansion And Health Services Use For Adults Experiencing Homelessness In Arkansas.

Health Aff (Millwood) 2021 01;40(1):91-97

Joseph Thompson is the president and CEO at the Arkansas Center for Health Improvement and a professor of health policy and management in the Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences.

More than 500,000 people in the US experience homelessness at any given time, many of whom now qualify for Medicaid in states that expanded coverage under the Affordable Care Act (ACA). In this article we use a novel data set from Arkansas to provide the first estimates of the association between gaining coverage through the ACA's Medicaid expansion and health services use for a population experiencing homelessness. We find that Medicaid expansion was associated with large initial increases in inpatient hospitalizations and emergency department visits-which declined steadily over time-among adults experiencing homelessness compared with use by a sample of adult traditional Medicaid enrollees. Our results provide evidence of substantial pent-up demand for health care among a population experiencing homelessness in Arkansas that gained health insurance coverage as a result of Medicaid expansion.
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http://dx.doi.org/10.1377/hlthaff.2019.01812DOI Listing
January 2021

The Effect of Medicaid Physician Fee Increases on Health Care Access, Utilization, and Expenditures.

Health Serv Res 2018 04 16;53(2):690-710. Epub 2017 Apr 16.

Mountain View, CA.

Objective: To evaluate the effect of Medicaid fee changes on health care access, utilization, and spending for Medicaid beneficiaries.

Data Source: We use the 2008 and 2012 waves of the Medical Expenditure Panel Survey linked to state-level Medicaid-to-Medicare primary care reimbursement ratios obtained through surveys conducted by the Urban Institute. We also incorporate data from the Current Population Survey and the Area Resource Files.

Study Design: Using a control group made up of the low-income privately insured, we conduct a difference-in-differences analysis to assess the relationship between Medicaid fee changes and access to care, utilization of health care services, and out-of-pocket medical expenditures for Medicaid enrollees.

Principal Findings: We find that an increase in the Medicaid-to-Medicare payment ratio for primary care services results in an increase in outpatient physician visits, emergency department utilization, and prescription fills, but only minor improvements in access to care. In addition, we report an increase in total annual out-of-pocket expenditures and spending on prescription medications.

Conclusions: Compared to the low-income privately insured, increased primary care reimbursement for Medicaid beneficiaries leads to higher utilization and out-of-pocket spending for Medicaid enrollees.
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http://dx.doi.org/10.1111/1475-6773.12698DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5867180PMC
April 2018

Cross-Continuum Tool Is Associated with Reduced Utilization and Cost for Frequent High-Need Users.

West J Emerg Med 2017 Feb 9;18(2):189-200. Epub 2016 Dec 9.

Trinity Health-Michigan dba Mercy Health Saint Mary's, Grand Rapids, Michigan.

Introduction: High-need, high-cost (HNHC) patients can over-use acute care services, a pattern of behavior associated with many poor outcomes that disproportionately contributes to increased U.S. healthcare cost. Our objective was to reduce healthcare cost and improve outcomes by optimizing the system of care. We targeted HNHC patients and identified root causes of frequent healthcare utilization. We developed a cross-continuum intervention process and a succinct tool called a Complex Care Map (CCM)© that addresses fragmentation in the system and links providers to a comprehensive individualized analysis of the patient story and causes for frequent access to health services.

Methods: Using a pre-/post-test design in which each subject served as his/her own historical control, this quality improvement project focused on determining if the interdisciplinary intervention called CCM© had an impact on healthcare utilization and costs for HNHC patients. We conducted the analysis between November 2012 and December 2015 at Mercy Health Saint Mary's, a Midwestern urban hospital with greater than 80,000 annual emergency department (ED) visits. All referred patients with three or more hospital visits (ED or inpatient [IP]) in the 12 months prior to initiation of a CCM© (n=339) were included in the study. Individualized CCMs© were created and made available in the electronic medical record (EMR) to all healthcare providers. We compared utilization, cost, social, and healthcare access variables from the EMR and cost-accounting system for 12 months before and after CCMs© implementation. We used both descriptive and limited inferential statistics.

Results: ED mean visits decreased 43% (p<0.001), inpatient mean admissions decreased 44% (p<0.001), outpatient mean visits decreased 17% (p<0.001), computed tomography mean scans decreased 62% (p<0.001), and OBS/IP length of stay mean days decreased 41% (p<0.001). Gross charges decreased 45% (p<0.001), direct expenses decreased 47% (p<0.001), contribution margin improved by 11% (p=0.002), and operating margin improved by 73% (p<0.001). Patients with housing increased 14% (p<0.001), those with primary care increased 15% (p<0.001), and those with insurance increased 16% (p<0.001).

Conclusion: Individualized CCMs© for a select group of patients are associated with decreased healthcare system overutilization and cost of care.
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http://dx.doi.org/10.5811/westjem.2016.11.31916DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5305124PMC
February 2017

Donor registries, first-person consent legislation, and the supply of deceased organ donors.

J Health Econ 2016 09 27;49:70-5. Epub 2016 Jun 27.

Grand Valley State University, 50 Front Ave SW, Grand Rapids, MI 49504, United States.

In this paper, we exploit the varied timing in state adoption of organ donor registries and first-person consent (FPC) legislation to examine corresponding changes in the supply of deceased organ donors. Results indicate that the establishment of a state organ donor registry leads to an increase in donation rates of approximately 8%, while the adoption of FPC legislation has no effect on the supply of organ donors. These results reinforce the need to encourage individuals to communicate their donation preferences, either explicitly via a registry or by discussing them with family.
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http://dx.doi.org/10.1016/j.jhealeco.2016.06.009DOI Listing
September 2016

Medicare Managed Care Spillovers and Treatment Intensity.

Authors:
Kevin Callison

Health Econ 2016 07 11;25(7):873-87. Epub 2015 May 11.

Grand Valley State University, Grand Rapids, MI, USA.

Evidence suggests that the share of Medicare managed care enrollees in a region affects the costs of treating traditional fee-for-service (FFS) Medicare beneficiaries; however, little is known about the mechanisms through which these 'spillover effects' operate. This paper examines the relationship between Medicare managed care penetration and treatment intensity for FFS enrollees hospitalized with a primary diagnosis of AMI. I find that increased Medicare managed care penetration is associated with a reduction in both the costs and the treatment intensity of FFS AMI patients. Specifically, as Medicare managed care penetration increases, FFS AMI patients are less likely to receive surgical reperfusion and mechanical ventilation and to experience an overall reduction in the number of inpatient procedures. Copyright © 2015 John Wiley & Sons, Ltd.
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http://dx.doi.org/10.1002/hec.3191DOI Listing
July 2016

Youth employment and substance use.

Soc Sci Res 2013 Jan 9;42(1):169-85. Epub 2012 Aug 9.

Institute of Government and Public Affairs, University of Illinois, 815 West Van Buren Street, Suite 525, Chicago, IL 60607, United States. Electronic address:

A significant portion of teens work while in school and the consequences of that work are of potential concern to society. While there is widespread support for combining work and school, and some evidence that employment has positive effects on youth development, previous research has revealed some potentially harmful consequences of employment among teens. In this paper, we investigate the relationship between teen employment and substance use. We extended this literature by studying two different cohorts of youth, and by exploiting arguably exogenous variation in youth employment and earnings caused by changes in minimum wages and the business cycle (unemployment). Estimates suggest that hours of work are positively associated with alcohol and cigarette use. However, if selection on unobserved variables were equal to selection on observed variables, these associations would be close to zero. With respect to the association between earnings and substance use, the evidence is less clear.
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http://dx.doi.org/10.1016/j.ssresearch.2012.07.007DOI Listing
January 2013
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